18 Does overweight enhance foot disorders in patients with juvenile idiopathic arthritis?

Abstract Background Juvenile idiopathic arthritis (JIA) is chronic inflammatory arthritis of childhood that may result in persistent and disabling foot impairments. Foot disorders are common in JIA with a prevalence estimated at over 90%. Many factors can worsen foot disorders in these patients. The influence of weight on foot disorders is poorly studied. Objectives To examine associations between weight and foot disorders in patients with JIA. Methods Patients with a diagnosis of JIA, based on the International League of Associations for Rheumatology (ILAR) criteria were included. Age, gender, weight, characteristics of the disease and of foot pain were noted. A specialized podiatric examination was performed. Results Thirty-two patients were included. The mean age was 12.2 ± 2.9 [5–18]. Forty-three percent of the patients were boys (n = 14). The mean age of disease onset was 8.5 ± 3.9 [3–15]. Only one patient had a triggering factor (elbow fracture). The most common type of JIA was oligoarthritis in 12 cases, then enthesitis-related in 8 cases, polyarthritis without rheumatoid factor in 3 cases, polyarthritis with positive rheumatoid factor in 1 case, psoriatic arthritis in 3 cases, systemic arthritis in 1 case and undifferentiated arthritis in 4 cases. The mean weight was 43.5 kg [17–98]. Only 28% (n = 9) of the children had a normal weight for their age, 41% (n = 13) of them had a low weight for their age and 31% (n = 10) of them had overweight. Ten patients had foot pain: hindfoot pain in 5 patients, midfoot pain in 3 patients, and forefoot pain in 2 patients. Foot deformities were found in 78.1% of the patients (n = 27): flat foot in 39% (n = 13) of the patients and pes cavus in 39% (n = 13). There was no association between overweight and foot pain (p = 0,14) or hindfoot pain (p = 0.08). However, overweight was associated with a forefoot (p = 0.01) and midfoot (p = 0.01) pain. Overweight was not associated with foot deformities (p = 0.1). Conclusion This study showed that weight is associated with foot pain especially forefoot and midfoot pain. A healthy lifestyle and a normal weight are fundamental to preventing foot pain at an early age in patients with JIA and improving their quality of life.


Background
The incidence of infections in patients with chronic inflammatory rheumatic disease is increased. It is often due to the disease itself and to the immunosuppressive treatments used. Objectives To assess the incidence of infections during JIA.

Methods
We conducted a repeated cross-sectional study including 29 patients followed for JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period from 1994 to 2022. Sociodemographic and anthropometric parameters, clinical data, biological assessments, and prescribed therapies were collected. We identified patients who had at least one infectious episode during their follow-up.

Conclusion
The risk of infections is increased during JIA. This is due to the immunosuppression induced by the disease, the treatment, and comorbidities.

Objectives
To identify the factors associated with anaemia in JIA.

Methods
We conducted a retrospective study including adults with longstanding JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years . Demographic, clinical, biological, and radiographic data were collected. These parameters were compared according to the presence or absence of anaemia.

Results
Seventeen women and 12 men were enrolled. The mean age was 35.69 AE 11.72   NSAIDs, corticosteroids and methotrexate were used in 62.1% (n ¼ 18), 69% (n ¼ 20) and 79.3% (n ¼ 23) respectively. Anaemia was noted in 69% (n ¼ 20) of cases, it was hypochromic in 8 cases and microcytic in 11 cases. The mean haemoglobin value was 11.31 2.10 [6.5-15] g/dl. Anaemia was associated with the following parameters in our study: female sex (88.2% vs 41.7%; p ¼ 0.008), absence of anti-nuclear antibodies (76.9% vs 20%; p ¼ 0.026) and corticosteroid therapy (85% vs 33.3%; p ¼ 0.005). However, the comparison of patients according to the presence of anaemia did not show any significant difference for these parameters: age, age at onset, diagnostic delay, duration of symptoms, extra-articular manifestations, CRP value, presence of biological inflammatory syndrome, rheumatoid factor, ACPA, erosive nature and treatment (NSAIDs and methotrexate).

Conclusion
Anaemia is common in JIA. Its treatment is part of the overall management of the disease. Background Juvenile idiopathic arthritis (JIA) is chronic inflammatory arthritis of childhood that may result in persistent and disabling foot impairments. Foot disorders are common in JIA with a prevalence estimated at over 90%. Many factors can worsen foot disorders in these patients. The influence of weight on foot disorders is poorly studied. Objectives To examine associations between weight and foot disorders in patients with JIA.

Methods
Patients with a diagnosis of JIA, based on the International League of Associations for Rheumatology (ILAR) criteria were included. Age, gender, weight, characteristics of the disease and of foot pain were noted. A specialized podiatric examination was performed.

Results
Thirty-two patients were included. The mean age was 12.2 AE 2.9 [5-18]. Forty-three percent of the patients were boys (n ¼ 14). The mean age of disease onset was 8.5 AE 3.9 [3-15]. Only one patient had a triggering factor (elbow fracture). The most common type of JIA was oligoarthritis in 12 cases, then enthesitis-related in 8 cases, polyarthritis without rheumatoid factor in 3 cases, polyarthritis with positive rheumatoid factor in 1 case, psoriatic arthritis in 3 cases, systemic arthritis in 1 case and undifferentiated arthritis in 4 cases. The mean weight was 43.5 kg . Only 28% (n ¼ 9) of the children had a normal weight for their age, 41% (n ¼ 13) of them had a low weight for their age and 31% (n ¼ 10) of them had overweight. Ten patients had foot pain: hindfoot pain in 5 patients, midfoot pain in 3 patients, and forefoot pain in 2 patients. Foot deformities were found in 78.1% of the patients (n ¼ 27): flat foot in 39% (n ¼ 13) of the patients and pes cavus in 39% (n ¼ 13). There was no association between overweight and foot pain (p ¼ 0,14) or hindfoot pain (p ¼ 0.08). However, overweight was associated with a forefoot (p ¼ 0.01) and midfoot (p ¼ 0.01) pain. Overweight was not associated with foot deformities (p ¼ 0.1).

Conclusion
This study showed that weight is associated with foot pain especially forefoot and midfoot pain. A healthy lifestyle and a normal weight are fundamental to preventing foot pain at an early age in patients with JIA and improving their quality of life. Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. JIA likely has a complex aetiology, with multiple genetic and environmental factors contributing to its development. Existing data on associations between maternal and early childhood exposures and JIA is rare. Previous studies showed potential role for prematurity, number of siblings and infections.

Objectives
The aim of our study is to assess maternal and early childhood exposures in patients with JIA.

Methods
Mothers of children with JIA followed in rheumatology department were asked about maternity related data as well as the course of perinatal period of the child with JIA based on the International League of Associations for Rheumatology (ILAR) criteria. Exposure information from birth included: Maternal factors (age when they had the first child, age when they had the child with JIA, plurality (singleton, twin/multiple gestation), number of prior fetal losses, number of prior births; delivery method (vaginal, cesarean section)) and also information about birth weight (low (<2500 grams), normal (2500-4000 grams), excessive (4000þ grams)); size for-gestational-age and gestational age (preterm, normal term, post term) and postpartum complications.

Results
Thirty children (sixteen females and fourteen males) with JIA were included. The most common type of JIA was enthesitis-related in 13 cases, then oligoarthritis in 8 cases, polyarthritis without rheumatoid factor in 4 cases, polyarthritis with positive rheumatoid factor in 2 cases and psoriatic arthritis in 3 cases. The mean age of the mothers was 27.1 years [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] when they had their first child and 30.27 years  when they had their child with JIA. They were nulliparous in 40% of the cases. All of the children were from a singleton pregnancy. Thirty percent of the mothers had at least one prior fetal loss before they had their child with JIA. During their pregnancy with their child with JIA, five mothers had pre-eclampsia and two of them had gestational diabetes. None of them smoked during the pregnancy. Only 2 children had preterm birth. Birth weight was normal (2.500-4.000 grams) in 24 cases, low in 3 cases (<2.500 grams) and above normal (>4000 grams) in 3 cases. Size for gestational age was normal in all cases. Nineteen mothers had vaginal delivery and eleven had cesarean section. Neonatal complications were noted in 7 cases who needed to be admitted to neonatal intensive care unit (1 for hypoglycemia, 1 for jaundice, 2 for infection, 1 for respiratory distress and two because of preterm birth). Maternal complications were noted in four cases: 2 postpartum hemorrhage and 2 postpartum infections.

Conclusion
Our study assessed maternal and early childhood exposures in patients with JIA. Further studies are required to explore associations between these factors and the occurrence of the disease for a better knowledge of etiologies of JIA and for a possible prevention from this pathology.

Background
Although ankle and foot involvements are common in juvenile idiopathic arthritis (JIA), they are often neglected. Hip involvement, also common in JIA, may affect these joints by creating a chronic imbalance of the musculoskeletal system. However, no studies have been published on this subject. Objective We aimed to describe ankle and foot impairment in a cohort of patients with JIA and to study the correlation between these impairments and the presence of hip arthritis. Methods A monocentric cross-sectional study was conducted including JIA patients fulfilling the 2001 ILAR criteria. Patients with congenital malformation of the ankle or foot or with any other foot impairment due to a disease other than JIA were not included. Foot examination was performed on bare feet both in supine and standing position. We completed with an analysis of footprint with a podoscope and shoes examination. Patients were divided in two groups depending on the presence or the absence of hip arthritis on pelvis X-ray, hip ultrasound or hip magnetic resonance imaging.

Results
We included 35 patients (M/F ¼ 15/20). Hip arthritis was noted in 45.7%. Oligoarticular (43.8%) and enthesitis-related arthritis (25%) were the most frequent form of JIA. Functional complaints related to foot and ankle were reported in 34.3% of cases. The pain was the most frequent symptom (91%), mainly in the hindfoot and ankle (50%). Foot pain was more frequently encountered in the absence of hip arthritis (52%, vs 31.2% in presence of hip arthritis). Physical examination revealed limitation of the talocrural joint in 20% of cases and feet tenosynovitis in 14.3% of cases. Achille tendon enthesitis was found in 8.6% of patients. These abnormalities were more prevalent in the absence of hip arthritis. Half of the patients had hindfoot deviation dominated by hindfoot varus (22.9%). In the group with hip arthritis, a hallux valgus was found in 14.3%, a supraductus of the 2 nd toe, and claw toe in one case each. An anomaly of the footprint was noted in 28 patients, including 11 in the group with hip involvement: 7 cases of cavus foot and 4 cases of flat foot. There were no correlations between foot or ankle anomalies with hip impairment apart from an association of flat foot with the absence of coxitis, and a leg length discrepancy more important in the group with hip arthritis.

Conclusions
Our study confirms the frequency of foot and ankle involvement as well as hip arthritis during JIA, hence the importance of their systematic screening even in asymptomatic children. Larger-scale studies would be necessary to evaluate with more precision the relation that there could be between hip and foot impairment. Key words: juvenile idiopathic arthritis, hip, foot, ankle.

Objective
To determine the link between BMI and disease activity in JIA patients.

Methods
We conducted a cross-sectional study including 35 JIA patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria. For each patient, we collected the following data: age, age at the onset of JIA, disease duration, patient global assessment (PGA), visual analogic scale (VAS), tender joint count (TJC), swollen joint count (SJC), disease activity using the Juvenile Arthritis Disease Activity score (JADAS), and therapeutic management. The weight and height were measured for each patient. The BMI was calculated and interpreted according to the World Health Organization classification.